Introduction: Due to restrictive adhesions lead removal without technical support is mostly impossible
in patients >1 y after implantation. In addition some patients reveal to have subclavian
or caval vein occlusions complicating the implantation of new leads. Laser-lead-extraction
using the excimer laser offers the possibility for secure lead removal and for re-canalization
of occluded veins.
Methods: LLD locking stylets, 12–16 French „Laser Sheaths“ and an excimer-laser as energy
source were used. Lead replacement was performed in Seldinger technique using the
canal created by the laser sheaths.
Results: Between 2001 and 2007 137 patients with pacemaker or ICD-lead infection or dysfunction
(mean time after implantation 6±4.8 years) underwent laser-lead-extraction. 12 patients
showed subclavian or caval vein occlusion in phlebography. Leads were extracted from
the right ventricle and/or the right atrium. Lead extraction and when necessary new
lead implantation was securely performed in all patients. Mean operation time was
49±29min. Mean fluoroscopy time was 4.1±2.8min. 4 of 137 patients (2.9%) developed
significant bleeding and underwent immediate sternotomy for surgical hemostasis with
uneventful postoperative course. No complications occurred in the recanalization group.
There were no long-term complications in any of those patients.
Conclusion: In the hands of experienced surgeons laser extraction in patients with or without
vein occlusions allows complete removal and replacement of pacemaker or ICD leads.
However possible complications of this technology necessitates close hemodynamic monitoring
including continuous TEE and cardiovascular surgery back up.
